By Lou Cannon
The Affordable Care Act, the Obama administration's vaunted plan for overhauling the nation's health care system, will cost more, insure fewer people and probably take longer to implement than originally planned.
States and the federal government are struggling to meet...

WASHINGTON, D.C. - (Mealey's) In a unanimous opinion, the U.S. Supreme Court on June 10 affirmed that an arbitrator acted within his powers under the Federal Arbitration Act (FAA) in determining that parties affirmatively "agreed to authorize class arbitration" in a case involving a dispute...

Arizona Gov. Jan Brewer (R) scored a huge political victory last week as Grand Canyon State lawmakers finally endorsed her call to greatly expand access to the state's Medicaid program. The expansion, part of the $8.8 billion budget lawmakers also adopted, is expected to provide health care coverage...

The Ohio Legislature has been out on its summer recess for almost two weeks, but Gov. John Kasich (R) has not given up hope lawmakers will return to Columbus sooner than later to green light his call to expand the Buckeye State's Medicaid rolls. At a pro-expansion rally last week, Kasich reiterated...

By Rich Ehisen
Faced with growing complaints from employers over the complexity of implementing the Affordable Care Act by next January, the Obama administration on July 2 announced it would postpone for one year enforcement of a provision of the law that requires large employers, those with 50 or...

By Gordon H. Copland |
A recent decision suggesting that the Virginia Certificate of Need (“CON”) law may be unconstitutional has widespread implications for CON laws around the country, including West Virginia and Kentucky. The surprising decision, by the Court of Appeals for the Fourth...

WASHINGTON, D.C. — (Mealey’s) U.S. Supreme Court Justice Sonia Sotomayor on Dec. 31 temporarily blocked the federal government from enforcing the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) against an order of Catholic nuns at the request of the...

WASHINGTON, D.C. — (Mealey’s) The U.S. Supreme Court on Jan. 24 enjoined the federal government from enforcing the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) against an order of Catholic nuns pending final disposition of an appeal by the 10th...

By Frederick Robinson , Megan Fanale Engel , Cori Annapolen Goldberg and Selina Coleman
On January 31, 2014, the U.S. Department of Health and Human Services Office of Inspector General (OIG) published its Work Plan for fiscal year 2014. The OIG announced that in the upcoming year, it will continue...

By Marcus C. Hewitt
H.H.S’s Office of Inspector General’s yearly work plan was issued on January 31, 2014, which included numerous new and ongoing reviews and activities by OIG for the coming year. Among the new projects, OIG will review Medicare payments to hospitals for outpatient evaluation...

By Gayland Hethcoat
With the release of its work plan for fiscal year 2014 on Jan. 31, 2013, the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) has provided insight on the agency’s current enforcement priorities in Medicare, Medicaid, and other HHS programs...

By Nita Garg
On April 1, President Obama signed the Protecting Access to Medicare Act of 2014. This legislation extends current Medicare physician reimbursement rates and delays implementation of the ICD-10 code for a full year. Previously, hospitals were to be ICD-10 compliant by October 1, 2014;...

By Mary B. Langowski and Kristen E. Ratcliff A little more than five years after the passage of the Health Information Technology Economic and Clinical Health (HITECH) Act, the Food and Drug Administration, Federal Communications Commission and the Office of the National Coordinator for Health IT have...

What do a moving company and a hospital association have in common? The False Claims Act (FCA).
The American Hospital Association along with the United States Chamber of Commerce and the Pharmaceutical Research and Manufacturers of America recently submitted an amici curiae brief in support of petitioners...

By David Y. Bannard
Not-for-profit health care providers that have borrowed on a tax-exempt basis within the last five years should be aware of the Securities and Exchange Commission’s (SEC) Municipalities Continuing Disclosure Cooperation (“MCDC”) Initiative. The MCDC Initiative...

By Benjamin Koplin , Selina Coleman and R. Jeffrey Layne
Despite extending the dispute-and-resolution deadline to account for the days that the Centers for Medicare & Medicaid Services (CMS) pulled down the reporting system, the public Physician Payments Sunshine Act website is still expected...

By Mark Faccenda
On August 29, 2014, the Centers for Medicare and Medicaid Services (“ CMS ”) announced that certain providers with pending appeals of specified inpatient-status claims denied by Medicare contractors may elect to receive partial payment on those claims in exchange for the...

By Stephen L. Goff and John Barnes
The Affordable Care Act is moving millions of previously uninsured patients into commercial managed care health plans. As the healthcare system grapples with complexity of this shift, the size of disputes between healthcare providers and managed care payers, in terms...

By Savaria B. Harris and Mitka T. Baker
Forbes magazine has dubbed 2014 “The Year of the Whistleblower.” For healthcare providers, this designation has translated into millions of dollars in fines and penalties and the initiation of criminal investigations.
Just last month, the Health...

By: Karen Nelson
Much has been written about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its repeal of the Sustainable Growth Rate formula for physician compensation and the potential gainsharing safe harbor. But the Act also includes certain Medicare program integrity provisions...

By David Gruber, MD, MBA* |
Healthcare spending is forecast to increase from US$3 trillion in 2014 to US$5.2 trillion in 2023, reflecting a compound annual growth rate of 5.9 percent. US healthcare expenditures on a per capita basis are 1.9-2.6 times the amount spent by other developed nations despite...

By David Gruber, MD, MBA*
Healthcare spending is forecast to increase from US$3 trillion in 2014 to US$5.2 trillion in 2023, reflecting a compound annual growth rate of 5.9 percent. US healthcare expenditures on a per capita basis are 1.9-2.6 times the amount spent by other developed nations despite...